Gonorrhoea

In Britain during the last few years, it's become riskier to have unprotected casual sex – because of the increasing commonness of gonorrhoea.

And alarmingly, some strains of gonorrhoea have actually become resistant to the standard methods of treatment – so that it's more difficult for people to be cured. For instance, in late 2015 it was announced that a new and highly-resistant type of of the bacteria had been detected in the north of England.

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This new strain was first found in Leeds, but it is spreading rapidly among heterosexual men and women in various northern counties. Apparently, some of these patients have partners in other areas of the UK, so it is almost inevitable that the resistant germ will turn up all over the country.

This particular 'bug' does not respond to azithromycin, which is one of the standard antibiotics used in the treatment of gonorrhoea. Other antibiotics can still be used, but the choice is narrowing.

What is gonorrhoea?

During the late 20th century, gonorrhoea became more and more common in Britain, largely as a result of freer and easier attitudes to sex.

The incidence fell substantially during the first part of the 21st century, perhaps because more people were practising safe sex.

But in the last few years, the UK total has risen again to about 28,000 cases a year, one-third of whom are women. Around 30 per cent of males with gonorrhoea are men who have sex with men (MSM). Unfortunately, the gonorrhoea figures for gay men recently rose by 37 per cent in 12 months.

Gonorrhoea most frequently affects 15 to 30-year-old men and women. But in an age where some older citizens have started to go in for free-and-easy sex, we are actually starting to see quite a few cases of gonorrhoea among old age pensioners.

A new strain of gonorrhoea, called 'HO41' emerged from Japan in 2013, and is causing real problems in various parts of the globe because it is so resistant to treatment.

Please note that gonorrhoea is more common in many distant regions of the world, particularly parts of the tropics. Therefore, casual sex while overseas may be very risky.

How do you contract gonorrhoea?

Gonorrhoea is transmitted through sexual contact. This includes vaginal intercourse and anal intercourse.

Oral sex can also pass on the germ, and some people actually develop a sore throat due to gonorrhoeal infection. But sex workers and others may carry the bacterium in their throats without realising it.

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We recently attended a sexual diseases conference where researchers revealed that they had found a high incidence of gonorrhoea of the throat among British prostitutes because so many of them give oral sex several times per day.

Mothers infected with gonorrhoea can transfer the disease to their children during delivery. If they were untreated, such children would develop a serious inflammation of the eyes – which could result in blindness.

However, these days nearly all infected babies are rapidly cured by antibiotic eye drops.

What are the symptoms of gonorrhoea?

Of those infected, approximately half the women and a few of the men do not show any symptoms.

In men, the main symptom is painful urination. There's also a discharge from the tip of the penis, which may be white, yellow or green.

How can I avoid gonorrhoea?

If you're under the influence of alcohol or other drugs, don't even consider having sex with anyone.

Remember, oral sex and anal sex can transmit gonorrhoea.

How do the clinics diagnose and treat gonorrhoea?

The bacterium can be detected through obtaining a sample from the urethra (the urinary pipe), the cervix (the 'neck' of the womb) and the throat or the rectum.

But first of all, the clinic will want to have a look at a fresh specimen of your urine.

Clinic doctors and nurses are experts at painlessly taking drops of moisture from the urinary pipe, the vagina and cervix, the rectum and the throat.

These samples will be examined under a microscope immediately and also sent to a lab to be analysed, which takes a few days.

If you do have gonorrhoea, you'll be given the appropriate antibiotic – and this should cure you.

Gonorrhoea used to be treated very effectively with penicillin. But penicillin-resistant strains of the germ have emerged in the past 30 years. By 2011, about 18 per cent of cases in the UK were 'resistant'. So in Britain, the new treatment for gonorrhoea is an antibiotic called ceftriaxone (Rocephin), which given by injection at a dose of 500 mg. It should be accompanied by an oral dose of another antibiotic, called azithromycin (Zithromax). Unfortunately, it is to this drug that resistance is emerging in the
north or England at the moment.

Important: If you're allergic to the penicillin molecule (as many people are), tell the doctor! Instead of the above, you'll probably be treated with another antibiotic called ciprofloxacin.

All the above drugs can have side-effects and the clinic should warn you about these.

The clinic will ask you to give 'contact slips' to your recent sexual partner(s), so that they too can be tested and treated.

Nevertheless, anything you tell the clinic staff will be completely confidential. They will not even inform your own doctor that you have had gonorrhoea.

What happens if gonorrhoea is left untreated?

If gonorrhoea is left untreated, it can develop into an inflammation of the sexual organs in women, and in men it can develop into an inflammation of the epididymis (a tightly-coiled tube located next to the testicle) or other parts of the genitals.

Years later, it can also cause chordee, which is a painful bending of the penis.

In women, a possible long-term consequence of gonorrhoea is blockage of the Fallopian tubes, even if the person has never had any symptoms.

If this blockage happens, the passage of the fertilised egg into the womb becomes difficult, and so the risk of sterility and ectopic pregnancy increases.

Women may also develop acute salpingitis – a painful inflammation of the Fallopian tube.

So, gonorrhoea should always be treated very promptly.

What should I do if I think I've run a risk of gonorrhoea?

Call your local genitourinary medicine (GUM) clinic and arrange to go and see them ASAP. In the meantime, don't have sex.

Unfortunately, Government cuts have recently made it more difficult for the public to find the addresses of STI clinics. But you can get the phone number and address of the one nearest you by going onto the Family Planning Association website, going to their 'find a clinic section' and tapping in your postcode.

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